الملخص
Background and purpose:Limbs soft tissue sarcoma(STS)is a common malignant tumor,and surgical resection is the main treatment method for it.The concept of barrier made us realize the blocking effect of natural barrier on STS,and we aimed to search for tissues that can act as barrier,and to perform complete resection of surgical margins around the tissue barrier.This study aimed to investigate the feasibility,safety and prognosis of barrier resection in the treatment of limbs STS.Methods:From December 2013 to September 2016,data of 72 patients who underwent barrier resection of STS of extremities in department of oncosurgery,Minhang Branch,Fudan University Shanghai Cancer Center were retrospectively analyzed,and the resection margin was sampled.All 72 patients underwent preoperative magnetic resonance imaging(MRI)or computed tomography(CT)design,and the physiological barrier or at least 3 cm distance was found outward from the anatomical location of the tumor.And en bloc excision was performed outside this barrier or at a distance of 3 cm.The influence of postoperative pathological margin,musculoskeletal tumor society(MSTS)score and postoperative complications on the patients were analyzed.The 1-and 3-year locoregional recurrence-free survival(LRFS)rates and sarcoma-specific survival(SSS)rates were evaluated,and the influencing factors were analyzed.This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(number:1212117-12&1212117-12-1301).Results:All patients had negative margins.The 1-and 3-year LRFS rates were 98.2%and 93.3%,respectively.The 1-and 3-year SSS rates were 98.4%and 94.2%,respectively.The mean MSTS scores were 28.3 preoperatively and 25.5 postoperatively.Surgical complications were grade 1 to 2 in 20 cases and grade 3 in 1 case,and there were no grade 4 to 5 complications.Conclusion:Based on the combination of clinical,imaging and pathology data,barrier resection,including tumor resection and functional reconstruction,can be applied to the surgical treatment of STS,with good feasibility and safety,reliable margin and satisfactory local control.
الملخص
Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.
الملخص
Objective:To compare the effects of different doses of prednisone combined with voriconazole on lung function and IgE levels in patients with allergic bronchopulmonary aspergillosis.Methods:From January 2018 to December 2018, 100 patients with allergic bronchopulmonary aspergillosis who admitted to Shaoxing Central Hospital were selected in this research.The patients were divided into two groups by the random number table method, with 50 cases in each group.The control group received high-dose prednisone combined with voriconazole, while the observation group received low-dose prednisone combined with voriconazole.The clinical effects after treatment were compared, including forced vital capacity (FVC), forced expiratory volume at the first second (FEV 1), FEV 1/FVC, peripheral blood eosinophilia (EOS), IgE, tumor necrosis factor alpha (TNF-α ), interleukin-6 (IL-6), interleukin-8 (IL-8) and adverse reactions. Results:After treatment, the total effective rate of the observation group was 94.00%(47/50), which was higher than 68.00%(34/50) in the control group (χ 2=10.981, P<0.05). Before treatment, the FVC, FEV 1, FEV 1/FVC between the two groups showed no statistically significant differences (all P>0.05). After treatment, the FVC, FEV 1, FEV 1/FVC of the observation group [(3.29±0.21)L, (1.86±0.25)L, (73.81±5.16)%] were higher than those of the control group [(2.61±0.21)L, (1.58±0.28)L, (65.85±5.07)%], the differences were statistically significant( t=16.190, 5.274, 7.781, all P<0.05). Before treatment, the EOS and IgE levels in peripheral blood showed no statistically significant differences between the two groups (all P>0.05). After treatment, the peripheral blood levels of EOS and IgE [(0.21±0.11)×10 9/L, (187.36±37.12)U/mL] in the observation group were lower than those in the control group [(0.34±0.14)×10 9/L, (689.35±40.16)U/mL], the differences were statistically significant ( t=5.163, 64.907, all P<0.05). Before treatment, the levels of TNF-α, IL-6 and IL-8 showed no statistically significant differences between the two groups (all P>0.05). After treatment, the levels of TNF-α, IL-6 and IL-8 of the observation group [(13.59±5.14)pg/L, (6.15±3.01)ng/L, (276.25±87.51)ng/L] were lower than those of the control group [(19.48±5.01)pg/L, (10.25±3.52)ng/L, (322.27±99.74)ng/L], the differences were statistically significant ( t=5.802, 6.259, 2.452, all P<0.05). The overall incidence of adverse reactions in the observation group was 6.00%(3/50), which was lower than 26.00%(13/50) in the control group (χ 2=7.441, P<0.05). Conclusion:Low-dose prednisone combined with voriconazole in the treatment of patients with allergic bronchopulmonary aspergillus has significant effect, which can effectively improve the pulmonary function and IgE level of patients, and reduce adverse reactions.
الملخص
Objective To observe the effectiveness of probucol for non-proliferative diabetic retinopathy (NPDR) with hyperlipidemia.Methods Fifty-two patients (104 eyes) of NPDR with hyperlipidemia were enrolled in this study.The patients were randomly divided into treatment group and control group,26 patients (52 eyes) in each group.Both groups received diet and exercise guidance,oral hypoglycemic agents and (or) intensive insulin therapy.After blood sugar and blood pressure were controlled,the treatment group received probucol 0.5 g,two times per day; and the control group received atorvastatin of 10 mg,one time per day.The total course was 12 months.Before and after one,three,six and 12 months,all patients underwent vision,ophthalmoscope,fundus fluorescein angiography,blood and urine tested.Variations of visual acuity,fundus condition,macular edema,triglyceride (TG),total cholesterol (TC),low-density lipoprotein cholesterol (LDLC),high-density lipoprotein cholesterol (HDLC) and 8-0HdG were observed before and after treatment.Results The total effective rate of visual prognosis were 44.23％ and 40.38％ in the treatment group and the control group,the difference had no statistical significacy (Z＝-0.335,P＞0.05).Retinal hemorrhages and microaneurysms alleviated after treatment in both groups.The total efficiency of fundus prognosis was 65.38％ in the treatment group and 36.54％ in the control group,and the difference was statistically significant (Z=-2.973,P＜0.05).Macular edema was in six and five eyes in the treatment group and the control group respectively,which were lower than before treatment,the difference was statisticaly significant (x2=4.833,4.300; P＜0.05).Between the two groups,the difference was not statistically significant (x2 =0.102,P＞ 0.05).Twelve months after treatment,TG,TC and LDLC were decreased in the treatment group (t=15.653,7.634,14.871) and control group (t=13.275,7.415,13.632),and the difference was statistically significant (P＜0.05).HDLC showed no significant difference than before in the two groups (t=0.584,0.275; P＞0.05).TG,TC,LDLC and HDLC showed no difference between the two groups (t＝1.857,0.133,1.671,0.875; P＞0.05).8-0HdG decreased gradually during the one,three,six and 12 months in the treatment group (t=7.352,15.581,27.324,28.143) and control group (t =6.877,8.672,14.671,14.855) after treatment,and the difference was statistically significant (P＜0.05).In the first month aftertreatment,8 0HdG showed no difference between the two groups (t=0.513,P＞0.05).In the 3,6,and 12 months after treatment,the 8 0HdG was lower in the treatment group than that in the control group,and the difference was statistically significant (t =3.434,5.917,5.226; P＜0.05).Conclusion In the treatment of NPDR with hyperlipidemia,probucol can reduce blood lipid,stable visual function and relieve macular edema.
الملخص
Objective To study the influence of probucol on the diabetic mellitus patients with non-proliferative diabetic retinopathy (NPDR) about blood lipids,serum level of the total antioxidant capacity (TAOC),malondialdehyde (MDA),superoxide dismutase (SOD) and macular edema,so as to provide clinical basis for the prevention and treatment of early DR by probucol.Methods 66 type 2 diabetes patients with 127 NPDR eyes were included.Patients were random divided into control and treatment groups,the control group was treated by intensive therapy of blood glucose and blood pressure control,and the treatment group was treated with the intensive therapy and probucol 0.375g,2 times a day for 12 months.Before and after treatment,the blood lipids,oxidative stress indicators and fundus fluorescein angiography in both groups had been determined.Results 62 cases with 120 eyes were enrolled in this study.Probucol obviously decreased levels of total cholesterol (TC) [ (3.6 ± 0.58) mmol/L VS (4.71 ± 0.61)mmol/L,t = 7.65,P ＜ 0.01 ],triglyceride (TG) [ (1.07 ± 0.35) mmol/L VS (1.23 ± 0.43) mmol/L,t = 2.02,P ＜ 0.05 ],low density lipoprotein cholesterol (LDLC) [ (2.0 ± 0.47) mmol/L VS (2.55 ±0.56)mmol/L,t =4.18,P ＜0.01] and MDA[ (10.35 ±2.97)nmol/L VS (14.83 ±2.75)nmol/L,t =6.18,P ＜0.01] in plasma of the patients.Levels of TAOC [(19.25±4.11)u/ml VS (16.63 ±3.27)u/ml,t =3.57,P ＜0.01 ]and SOD[ (94.52 ± 10.28)u/ml VS (75.37 ± 9.87) u/ml,t =8.62,P ＜0.01]were significantly improved in the probucol group,and the macular edema was significantly reduced in patients of the probucol group(x2 =4.219,P ＜0.05).Conclusion Probucol regulated serum lipids,and it had the apparent action of antioxidant,and it decreased the incidence of macular edema.Probucol had a therapeutic effect in patients with NDPR.